Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/92596
標題: 利用超音波診斷中大腦動脈狹窄
Using ultrasonography to diagnose middle cerebral artery stenosis
作者: 王麗雯
Li-Wei Wang
關鍵字: 中大腦動脈
middle cerebral artery
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摘要: 背景:腦血管超音波是臨床常用、非侵入性的檢查工具,可應用於診斷腦血管狹窄。目前臨床上使用之中大腦動脈流速常模是引用國外文獻統計結果,但不分年齡使用相同的流速上限值將提高誤診率,因此本研究目標為建立臺中榮總超音波室之正常腦血流速率參考值。 方法:由健檢中心及門診招募332 位健康人接受頸動脈超音波及穿顱彩色都卜勒超音波(TCCS)檢查,分析顱內外腦動脈血流速率以建立正常腦動脈血流流速之常模。病歷回顧分析233 位神經內科中風病患腦部核磁共振血管攝影(MRA)及超音波檢查數據,以MRA計算中大腦動脈狹窄程度,探討超音波診斷中大腦動脈狹窄之準確性。 結果:中大腦動脈血流流速與年齡,性別顯著相關,隨著年紀增長中大腦動脈血流流速越低;年齡對腦血流速率之影響力在女性較為明顯,尤其對年齡小於60 歲之女性影響最大。依據本研究建立之正常腦動脈血流流速參考值提出新的診斷標準,建議以顱內外流速比值(MCA/ICA PSV index)來消弭個體差異,針對年齡小於60 歲及大於等於60 歲之健康受試者提出兩個標準值上限:60 歲以下患者如顱內外血流流速比值(MCA/ICA PSV index)超過 1.58則懷疑有中大腦動脈狹窄,大於或等於60 歲患者如顱內外血流流速比值超過 1.93 則懷疑有中大腦動脈狹窄。以腦部核磁共振血管攝影(MRA)所判讀之中大腦動脈狹窄程度當作標準診斷,測試本研究所提出之超音波診斷參考值準確度,發現超音波診斷之敏感度( 48 %)及陽性預測值(21 %)不高,但有不錯之特異性(76%)與陰性預測值(92%)。 結論:超音波是一良好的篩檢工具,可用以初步篩檢辨別顱內中大腦動脈有無狹窄,年齡對腦動脈血流速率有很大影響,判讀超音波檢查數據時應將年齡納入診斷考量。
Background:Carotid ultrasound and transcranial color- coded duplex sonography (TCCS) are widely-used, non-invasive tools for detecting cerebral artery stenosis. The reference range of cerebral blood flow velocity was based on the literature reports from Caucasian populations. In addition, using the same reference range of flow velocities in young adults might lead to misdiagnosis since age significantly affects cerebral blood flow. The present study aims to establish the normal range of cerebral blood flow velocities in Taiwanese population. Methods:Carotid ultrasound and TCCS were performed in 332 healthy, asymptomatic subjects. The participants were divided into three age groups (<40 y/o, 40-60 y/o and ≧60 y/o) to evaluate the associations between age and cerebral blood flow velocities. Sex-specific analysis was also performed. Based on the distribution of flow velocities obtained from healthy subjects, we proposed new diagnostic criteria for middle cerebral artery (MCA) stenosis. Brain magnetic resonance angiography (MRA) of 233 stroke patients was reviewed. The severity of MCA stenosis of each participant was determined by MRA. The sensitivity, specificity, positive and negative predictive values of ultrasound diagnostic criteria were calculated. Results:Sex and age are significantly associated with cerebral blood flow. The average flow velocities for MCA in subjects younger than 40 y/o, 40-60 y/o, and ≧ 60 y/o are 109.8 ± 22.7, 98.2 ± 23.6, 89.7 ± 23.5 cm/sec respectively (ANOVA p <0.001). Women has significantly higher cerebral blood flow than men, especially in women younger than 60 y/o. We proposed MCA / ICA PSV index (i.e. the ratio of flow velocities between extracranial internal carotid artery and intracranial MCA) to be the new diagnostic criteria for MCA stenosis. A MCA/ICA index higher than 1.58 in subjects younger than 60 y/o suggested MCA stenosis; whereas an index higher than 1.93 in subjects elder than or equal to 60 y/o suggested MCA stenosis. We then applied the diagnostic criteria to stroke patients to evaluate its validity. Using MRA as golden standard, the sensitivity, specificity, positive and negative predictive values for ultrasound are 48%, 76%, 21%, and 92% respectively. Conclusions:Carotid ultrasound and TCCS are useful, screening tools for detecting intracranial cerebral artery stenosis. The influence of age and sex should be considered in the interpretation of cerebral blood flow velocities.
URI: http://hdl.handle.net/11455/92596
其他識別: U0005-2001201419382600
文章公開時間: 10000-01-01
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